New Report: “Dying alone is hard anywhere in the world” – palliative care in natural disaster response

READ THE FULL REPORT: Natural Disasters – Report and Recommendations

In response to the emerging recognition of the need for palliative care, the Humanitarian Health Ethics Research Group undertook a program of research in order to understand the ethical dimensions of palliative care during humanitarian action. Here, we present key findings of the sub-study focused on natural disaster settings that was part of this larger program of research. Through this series of reports, we hope to present the perspectives of those engaged in humanitarian healthcare firsthand – as patients, host community members, policymakers, and local and international healthcare providers – in order to clarify how humanitarian organizations and humanitarian healthcare providers might best support ethically and contextually-appropriate palliative care in a range of humanitarian crises.


  1. Participants described palliative care as a key component of comprehensive humanitarian healthcare involving companionship and psychosocial support for patients and their families, dignity in death and dying, and the management of pain and other distressing symptoms.
  2. Barriers to the provision of palliative care in natural disaster settings included damage to health structures; inadequate resources; disrupted supply chains; the invisibility of patients with palliative needs; differences in local cultural norms; the prioritization of acute needs; and challenges of mobility and access to care.
  3. Despite existing limitations, respondents agreed that humanitarian aid organizations have an ethical obligation to provide palliative care.
  4. Integration of palliative care may play a role in alleviating distress among disaster responders, particularly those from affected communities.
  5. Participants emphasized that palliative care must be integrated into disaster planning from the beginning; otherwise, it is likely to be neglected during a crisis.
  6. There was a clear consensus concerning the need for palliative care training and protocols to guide practice in natural disaster settings.

Suggested citation: Amir, T., Yantzi, R., de Laat, S., Bernard, C., Elit, L., Schuster-Wallace, C., Redwood Campbell, L., Hunt, M. & Schwartz, L. (2020). “Dying alone is hard anywhere in the world”: Palliative care in natural disaster response. Isis A. Harvey designer. Available online at

Priceless: the value of building an international collaborative team

As presented by Olive Wahoush at the 1st World Congress on Migration, Ethnicity, Race and Health (MERH), 17-19 May 2018 in Edinburgh, Scotland.

Downland the PDF version.

Call for Case Studies


Call for submissions for case studies:  Refugee Health

The ongoing Syrian civil war ranks as the worst humanitarian catastrophe in modern times. Nearly twelve million Syrians have been forcibly displaced within their own country or have fled to neighbouring countries. Experiences of violence are compounded by significant stressors, such as perilous living conditions, loss of family and social supports, discrimination, exploitation, risk of retraumatization, and lack of access to primary care and/or education caused by violent conflict and long periods in refugee camps.

The Federal Government has implemented a humanitarian program to resettle 25,000 Syrian refugees in Canada in the next few months ( It has invested tremendous resources to provide “rapid protection for vulnerable Syrian refugees while continuing to protect the health and safety of Canadians” – a precarious balance to maintain given the many challenges of resettlement faced by both the refugee and host populations.

The integration of Syrian refugees into Canadian society and specifically into the health care system raises a number of ethical issues about refugee health, the appropriate role of health care providers, and what constitutes adequate care during the integration process. Ethical issues include questions around the fair allocation of resources, equity of access and quality of care, both between refugees and host populations as well as between refugee populations living in the same country. Other ethical issues include the mental health impact of trauma and war, vulnerability, cultural humility, and medical interpretation.

BioéthiqueOnline  invites submissions of case studies that discuss the ethical issues raised by refugee health, explored from a theoretical lens or from the perspective of how they apply in practice. BioéthiqueOnline ’s objective is to broaden our understanding of refugee health and the interplay of ethical issues in “real-life” contexts.


Case studies should be between 750 and 1200 words (no more than 1500); see examples at: .

The deadline for submissions is 1 October 2016.

Submission :<>



Appel à soumission d’études de cas:  La santé des réfugiés

La guerre civile qui sévit en Syrie est considérée comme la pire catastrophe humanitaire des temps modernes. Près de douze millions de Syriens ont été déplacés de force dans leur propre pays ou ont fui vers les pays voisins. Les expériences de violence sont exacerbées par des facteurs de stress importants. On en cite les conditions de vie périlleuses, la perte de tout soutien familial et social, la discrimination, l’exploitation, le risque d’un nouveau traumatisme et le manque d’accès aux soins primaires et/ou de l’éducation causés par des conflits violents et de longues périodes dans des camps de réfugiés.

Le gouvernement fédéral canadien a mis en œuvre un programme humanitaire qui a permis d’accueillir 25 000 réfugiés syriens au Canada ( Des ressources considérables ont été investies afin de fournir « une protection rapide des réfugiés syriens vulnérables tout en continuant à protéger la santé et la sécurité des Canadiens » – un équilibre précaire à maintenir, compte tenu des nombreux défis de réinsertion auxquels les réfugiés et les populations d’accueil sont confrontés.

L’intégration des réfugiés syriens dans la société canadienne, en particulier dans le système de soins de santé, soulève un certain nombre d’enjeux éthiques portant sur : la santé des réfugiés, le rôle approprié des professionnels de santé, et notamment les soins appropriés qui devraient être fournis au cours d’un processus d’intégration. Les enjeux éthiques comprennent des questions liées à la répartition équitable des ressources, à l’équité d’accès et à la qualité des soins entre les réfugiés et les populations d’accueil, mais également entre les populations réfugiées d’un même pays.

D’autres enjeux éthiques incluent les conséquences des traumatismes et des guerres sur la santé mentale, la vulnérabilité, l’humilité culturelle et l’interprétation médicale.

BioéthiqueOnline  vous invite à soumettre des études de cas qui traitent des enjeux éthiques soulevés par la santé des réfugiés, à partir d’une perspective théorique ou d’un point de vue pratique. L’objectif de BioéthiqueOnline  est d’approfondir notre compréhension concernant la santé des réfugiés et l’interaction des questions éthiques dans la réalité de la vie quotidienne.


Les études de cas devraient être entre 750 et 1200 mots (à ne pas dépasser 1500); pour voir des exemples: .

La date limite pour les soumissions est le 1er octobre 2016.

Soumission :<>

New Case Study Available

Case studies are made available for a variety of training and reflection purposes. They can be used in conjunction with the Humanitarian Health Ethics Analysis Tool (HHEAT) or on their own.

Are Injections Better Than Pills?

Two months ago, an international medical NGO established a project to support local health clinics and introduce a new malaria treatment program that consists of taking two pills once a day for three days. It would replace the currently available treatment of daily injections. Local health professionals are hesitant about the change in treatment protocol when it is presented to them. The local community, including some local health workers, voice their concern about this treatment; in their opinion injections are better than pills, and more pills are better than a few.  Some local health workers are also sceptical that this new treatment regimen will be available once the non-governmental organization leaves the area. What’s more, community health workers have heard that some local health providers have discouraged patients from accepting the new treatment.

Read the full case.

Case Study: Co-opting of Aid Organizations

An international medical NGO is staffing a health clinic in a remote village located near a large-scale agriculture enterprise operated by a multinational corporation. Many of the clinic’s patients are migrant workers who have come to the region seeking work at the commercial farm. Employees receive low wages by local standards, work very long hours, and have poor living conditions. Many of the workers and their family members present to the clinic with signs of malnutrition. A number of them also report respiratory complaints and skin and eye problems, which they associate with their handling of pesticides on the large farm.